Membership Form

Membership Status*

New MembershipRenewal Membership

Name*

First NameLast Name

Family Membership name (Spouse)

First NameLast Name

Family Membership name (Child)

First NameLast Name

Family Membership name (Child)

First NameLast Name

Family Membership name (Child)

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Cell Number*

Please enter a valid phone number.

Home Number

Please enter a valid phone number.

Email*

example@example.com

Boat Owner*

YesNo

State Registration Number Make and Model Length Color Engine HP
Boat Owners must include proof of $300,000 minimum liability insurance.

IN CONSIDERATION of being permitted to compete, observe, or participate in any way in the EVENT(S) sponsored by the Fox Valley Area Anglers, each of the undersigned, for himself, his personal representatives, heirs, and next of kin:

Hereby releases, waives, discharges and covenants not to sue Fox Valley Area Anglers fishing club for any and all loss or damage, and any claim or demands therefore on account of injury to the person or property or resulting in death of the undersigned arising out of or related to the event(s) sponsored by the Fox Valley Area Anglers fishing club, whether caused by the negligence of the releasees or otherwise.
Hereby agrees to indemnify and save and hold harmless the releasees and each of them from any loss, liability, damage, or cost they may incur arising out of or related to the event(s) whether caused by the negligence of the releasees or otherwise.
Hereby assumes full responsibility for any risk of bodily injury, death or property damage arising out of or related to the event(s) whether caused by the negligence of releasees or otherwise.
Hereby acknowledges that the activities of the event(s) are dangerous and involve the risk of serious injury and/or death and/or property damage. Each of the undersigned, also expressly acknowledges the injuries received may be compounded or increased by negligent rescue operation or procedures of the releasees.
Hereby agrees that this release and waiver of liability, assumption of risk and indemnity agreement extends to all acts of negligence by the releasees, and is intended to be as broad and inclusive as is permitted by the laws of the Province or State in which the event(s) is/are conducted and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding continue in full legal force and effect.
The personal information you provide to the Fox Valley Area Anglers including your name, address, phone number and email address are solely for the use of the club and will not be sold or rented to any third parties.

I have read this release and waiver of liability, assumption of risk and indemnity agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and have signed it freely and voluntarily without any inducement, assurance or guarantee being made to me and intend my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.

Member Signature*

Familymember Signature

Please verify that you are human*